Feeding Your Baby the First Six Months

Human breast milk is the most natural milk to feed your baby, however, breastfeeding is a skill that requires planning, preparation and practice to master.

Breastfeeding comes with many benefits:

• Controls postpartum bleeding.
• Helps reduce risk of breast and ovarian cancer, and type 2 diabetes.
• Helps to release hormones that can benefit bonding and positive postpartum mental health.
• Provides all the nutrients a baby needs to grow.
• Protects babies from infections and helps babies fight illnesses.
• Reduces risk of childhood obesity.
• Lowers risk of allergies in children, especially if there is a family history.
• Is always available, ready to eat and free!

Learn more about the exclusive benefits of human milk.

It is important to prepare for feeding your baby while pregnant so you will feel confident during those first few days after your baby arrives. The choices you make before, during, and after birth will help get breastfeeding off to the best start.

Suggestions to prepare for breastfeeding while pregnant include:

1. Educate yourself: Learn about breastfeeding, its benefits, what is "normal" and when to get help by taking either a virtual or in person class. Read about breastfeeding, review resources from trusted breastfeeding sources such as About Breastfeeding.
2. Create a breastfeeding plan: During pregnancy, discuss your breastfeeding goals with your health care provider (e.g. doctor, midwife, doula, nurse, lactation consultant). Just like a birth plan, create a breastfeeding plan that includes how to protect your milk supply, what to do if there are medical interventions needed, and how to ensure that formula use is avoided unless medically necessary.
3. Prepare your breasts: Speak with your health care provider if you have flat, or inverted nipples or have had breast surgery or breast cancer. Some types of breast and nipple issues can cause breastfeeding problems. Learn about antenatal hand expression to collect colostrum. Preparation can begin in pregnancy to help lessen the impact of these concerns on breastfeeding success.
4. Prepare yourself: Breast milk is natural, however breastfeeding is a skill that may need time to learn. Breastfeeding can be challenging, but it can also be a rewarding experience. Visit About Breastfeeding, for information on how to take care of yourself while breastfeeding.
5. Purchase or borrow breastfeeding supplies: Some items that can make breastfeeding more comfortable include nursing bras, nursing pads, and a breast pump.
6. Find breastfeeding support: Know in advance where you can seek help or where to connect with other nursing parents and get answers to your questions. Learn about local breastfeeding clinics and services including prenatal, breastfeeding, and parenting services.

Here are a few suggestions for supplies to help with breastfeeding:

• Nipple ointment/cream (not always necessary).
• Breast milk storage bags/pumping supplies.
• Very firm supportive breastfeeding pillow (for use after the early days).
• Clothing to support nursing (not always necessary).
• A breast pump (see more information on pumping).

Avoid buying

• Pacifiers or artificial nipples.
• Breastfeeding supplements. Consult with a health care provider before using any supplements, as they may not be necessary or effective, and can negatively impact your breastfeeding goals.

Visit About Breastfeeding for more suggestions.

• Antenatal hand expression involves stimulating breast tissue and expressing colostrum by hand in the final weeks of pregnancy. This can begin typically after 37 weeks gestation unless advised not to by your doctor or midwife.
• Hand expression can increase confidence with breastfeeding, and helps the body produce more colostrum and milk.
• Babies benefit from early production of colostrum, it’s a protective factor for the immune system and is packed with healthy vitamins and nutrients.

Learn more about antenatal hand expression.

Here are some tips to help you get off to a good start:

• Hold your baby skin to skin often.
• Breastfeed soon after birth and often, expect to breastfeed 8 to 10 times a day.
• Your milk supply is directly linked to how often you feed the baby by breast.
• Ask the hospital staff not to give your baby formula, sugar water, artificial nipples, or pacifiers without your permission, unless it’s medically necessary.
• Have a hand expression plan in place in case you need to give baby formula (to protect your milk supply) and to bring milk in, learn how to hand express.
• Milk supply takes anywhere from three to five days to "come in".
• Keep baby alert and active at breast to ensure they are drinking enough. Watch the video attaching your baby at the breast.
• If a baby does not wake on their own within two to three hours after breastfeeding, all parents should wake their babies to start feeding.
• Breastfeeding should not hurt! If it hurts, adjusting the position to ensure baby latches deeply on the breast will help. Visit About Breastfeeding.
• Review About Breastfeeding getting off to a good start section to learn more about those crucial early days.

• Your first milk is called colostrum, which your body starts to make during pregnancy. It is thick, yellow, and has high amounts of germ-fighting cells. Colostrum helps protect the baby’s immune system, starts their bowel function, and gives them a high amount of nutrients.
• Colostrum comes in small amounts, it is perfect for your baby’s small stomach. Colostrum turns into milk around two to five days after birth.
• It is normal after the first 24 hours that your baby will feed often (8 to 12-plus times in 24 hours). It is common during this time to feel that you do not have enough milk, but don’t worry, your baby is just doing their job as this helps to bring your milk in.
• You can collect colostrum drops any time after 37 weeks of pregnancy by doing hand expression, to learn more about this skill visit express milk before birth.

To learn more about the important health benefits of human milk visit About Breastfeeding.

This is the most common concern from new parents about breastfeeding. You can not measure or see breastmilk when baby is latching and drinking.

There are many ways to know if your baby is getting enough milk.

• Baby feeds at least 8 to 10 feeds per 24 hours (no longer than three hours from the start of one feed to the start of the next feed).
• Your baby cues to feed, sucks and swallows while feeding, and is full and relaxed after feeds.
• Your baby is having the right amount of wet and dirty diapers based on age.
• If your baby does not have enough wet and dirty diapers for their age, get help right away!
• Position and latch supports deep latch, with out pain, and your baby’s jaw moves often while drinking. Watch the video attaching your baby at the breast.
• Baby’s has a wet, pink mouth and bright eyes.

There are several options for removing milk at the breast, including hand expression, single and double electric pumps, and manual pumps, choosing the right type of milk expression is important and can influence milk supply.

Some considerations when thinking about which pump to use are cost, portability, noise level, ease of use, efficiency, and effectiveness of removing milk. For example, a pump that helps to build milk supply would be a hospital grade electric pump, a pump that gently removes milk to reduce engorgement and maintain milk supply is a manual or hand pump.

Situations when expression of breast for milk is appropriate:

• To protect or build milk supply.
• Providing breast milk to babies who are not able to latch.
• Provide relief if breasts are too full/engorged.
• To support babies who may need extra milk.
• If you’re going to be away from your baby.
• If a medication is prescribed that is contraindicated while breastfeeding (ensure you speak with your health care provider to explore alternative medications if appropriate).

Strategies to increase your milk supply when pumping include:

• Frequent skin to skin and carry baby in a kangaroo hold.
• Frequent pumping from both breasts at least eight times in 24 hours.
• Use hands on pumping, a combination of electric pumping with breast message.
• Sleep a maximum of four hours in between pumping sessions, pumping at least once overnight.
• Power pumping to mimic your babies cluster feeding.
• It is more effective to use a comfortable vacuum setting and not the strongest one.

The length of pumping time will depend on the milk ejection reflex, but it typically takes 10 to 15 minutes, or longer if milk is still coming out.

You may be eligible for financial support for a pump purchase or rental, if you currently receive Ontario Works or Ontario Disability Support Program speak to your worker for more information or contact your employee health care benefits to discuss available support.

For more information on pumping visit Health Link BC - Pumping Breast Milk.

Many parents who return to work or school find they can maintain their breastfeeding relationship with their baby. When separated from your baby for long periods of time, you can express and store your breastmilk.

Below are some considerations regarding breastfeeding and returning to school/work:

• Select a child care provider close to your work/school, this will give you the opportunity to visit your child during the day and to breastfeed if you choose.
• Ask your child care provider to feed your expressed breast milk while you are away.
• You may need to pump or hand express and store milk while away from your child to maintain your supply.
• Hand expression/pumping can be done to provide breast milk for feedings, increase your comfort, and maintain your milk supply. The frequency of hand expression/pumping will depend on your feeding goals.

Most babies need only breast milk and vitamin D for the first six months. Solids are usually introduced when the baby is around six months old, while breastfeeding continues for up to two years or beyond. Breast milk will still remain an important part of your baby’s diet, as it provides immune protection and nutrients to your growing baby. Starting solids introduces important nutrients such as iron and a variety of textures to continue to support your baby’s growth and development. While starting solids it remains important to continue to breastfeed to protect your milk supply.

Learn more about Feeding your baby 6 to 12 months.

Nursing strike is when a baby who has been breast feeding well suddenly refuses the breast. This mostly occurs before the baby is 12 months old and can last a couple of days or longer. This is not the same as natural weaning when the baby moves from breast milk to other sources of food.

Sometimes the cause for the nursing strike is unknown, however the baby could be experiencing an ear infection, a cold or other illness, acid reflux or be stressed, upset or easily distracted.

Suggestions to assist with a baby strike could include the following tips:

• Breastfeed in a quiet place.
• Breastfeed when baby is sleepy.
• Change breastfeeding positions.
• Place baby skin to skin.
• Hand express before latching to start milk flow.
• Breastfeed based on feeding cues.
• Keep feeding times happy.

How long you can safely store breast milk depends on where you store it, and whether your baby is healthy or sick.

Here are helpful tips for storing your breast milk:

• After your baby is finished feeding, discard the remaining milk within one to two hours.
• Freshly expressed milk can be stored at room temperature for up to six hours.
• Cool down newly expressed milk before adding it to stored milk.

In the early days, your baby might fall asleep while or shortly after breastfeeding. Newborn babies sleep for 14 to 20 hrs a day, in short cycles. Newborns must eat regularly, eight or more times a day, and should be fed once every three hours. You may need to wake your baby to breastfeed until your baby is waking regularly on their own and their back to birth weight. Babies born at 37 weeks or younger, or who have jaundice or other medical conditions, must be monitored closely to ensure they are eating enough milk.

For questions or concerns visit Prenatal, Breastfeeding, and Parenting Services.

How to help a sleepy baby:

• Keep your baby close to you so you notice when they are showing early signs of hunger.
• Hand express a little bit of milk when you bring your baby to the breast, letting baby know there is milk present.
• Switch sides frequently during a feeding, this helps baby get a let down, and also helps to "wake" them up a bit.
• Ensure baby is latched deeply and positioned comfortably, a deep latch triggers the sucking reflex. If the baby’s sucking and swallowing starts to slow down while breastfeeding, you can compress the breast to remind him that there is milk and encourage him to keep feeding until full.

If your baby is not latching or drinking at the breast you will want to make sure your baby is being well fed and your milk supply is maintained. Pumping your breast at least eight times in 24 hours and feeding your baby your expressed milk may be necessary as you work to get your baby onto the breast.

Speak to a health care professional as soon as possible about ways to feed your baby which will not negatively impact breastfeeding. Spend time with your baby skin-to-skin and keep trying to latch the baby and breastfeed. Remember that most babies will eventually take the breast.

To get breastfeeding help visit Prenatal, Breastfeeding, and Parenting Services.

Breastfeeding shouldn’t hurt, if there is pain while breastfeeding, there could be issues with the latch. If the latch is painful, this can lead to skin breakdown, blocked ducts or blebs, may lead to ineffective milk removal and should be corrected quickly. Reviewing proper position and latch techniques at About Breastfeeding can be a great place to start.

To get breastfeeding help visit Prenatal, Breastfeeding, and Parenting Services.

• Breastfeeding is especially important for multiples as it provides optimal nutrition and immunological protection to often preterm or otherwise compromised infants, and ensures frequent contact with each baby.
• Parents of multiples may need help and support with early feedings as they try to figure out how to manage feeding more than one infant.
• A woman can produce enough milk to feed twins as milk production is based on supply and demand. The more milk demanded/removed means supply will increase.

For more tips on breastfeeding your multiples, please visit: Multiple Births Canada - Feeding.